Use a separate line for each person and list the following:
First and Last Name, Date of Birth, Phone Number, Email

Youth (Infant to 17 Years Old) *

Use a separate line for each person and list the following:
First and Last Name, Date of Birth, Grade, Email

Emergency Contact Name *

Emergency Contact Phone Number *

Primary Adult Agreeing to the Disclosure *

I have read and understand the Risk Disclosure and applicable Codes of Contact for the Grand Valley Recreation Center and the Parachute / Battlement Mesa Park and Recreation District Programs/Activities. I agree to follow all rules. I understand all fees paid to the Parachute / Battlement Mesa Park and Recreation District are not refundable or transferable, unless approved by the Program Director in advance.